Abstract
Primary hyperparathyroidism (PHPTH) is one of the most common metabolic conditions requiring surgical intervention. Today, with automated blood chemistry panels a routine part of medical care, the most typical presentation of PHPTH is that of asymptomatic hypercalcemia. The individual found to have an elevated serum calcium level may have one of several conditions, however, and other potential causes must be carefully excluded before making a diagnosis of PHPTH and proceeding to any consideration of operative intervention. Once a diagnosis of PHPTH is confirmed, a decision must be made regarding the need for parathyroidectomy. Medical management of the patient awaiting parathyroid surgery must take into account their calcium metabolic issues in the preoperative period, as well as prevention of postoperative complications. Individuals with PHPTH who do not require surgery need ongoing medical care and monitoring to prevent complications of PHPTH.
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Notes
- 1.
Renal calcium (Ca): creatinine (Cr) clearance ratio is calculated from a spot urine sample and simultaneous serum sample using the following formula:
$$[\text{Urine Ca}\times \text{Serum Cr}]/[\text{Urine Cr}\times \text{Serum Ca}]$$
References
Yamashita H, Gao P, Cantor T et al (2004) Comparison of parathyroid hormone levels from the intact and whole parathyroid hormone assays after parathyroidectomy for primary and secondary hyperparathyroidism. Surgery 135:149–156
Bilezikian JP, Khan AA, Potts JT Jr, Third International Workshop on the Management of Asymptomatic Primary Hyperthyroidism (2009) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab 94:335
Silverberg SJ, Shane E, Jacobs TP et al (1999) A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 341:1249
Marx SJ, Simonds WF, Agarwal SK et al (2002) Hyperparathyroidism in hereditary syndromes: special expressions and special managements. J Bone Miner Res 17(Suppl 2):N37–N43
Liamis G, Milionis HJ, Elisaf M (2009) A review of drug-induced hypocalcemia. J Bone Miner Metab 27:635
Eisner BH, Ahn J, Stoller ML (2009) Differentiating primary from secondary hyperparathyroidism in stone patients: the “thiazide challenge”. J Endourol 23:191
Lowe H, McMahon DJ, Rubin MR et al (2007) Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype. J Clin Endocrinol Metab 92:3001
McHenry CR, Lee K, Saadey J et al (1996) Parathyroid localization with technetium-99m-sestamibi: a prospective evaluation. J Am Coll Surg 183:25
Elaraj DM, Sippel RS, Lindsay S et al (2010) Are additional localization studies and referral indicated for patients with primary hyperparathyroidism who have negative sestamibi scan results? Arch Surg 145:578
http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/DRI-Values.aspxAccessed mar 2011.
Holick MF, Chen TC (2008) Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 87:1080S–1086S
Stewart ZA, Blackford A, Somervell H et al (2005) 25-hydroxyvitamin D deficiency is a risk factor for symptoms of postoperative hypocalcemia and secondary hyperparathyroidism after minimally invasive parathyroidectomy. Surgery 138:1018
Heaney RP (2005) The vitamin D requirement in health and disease. J Steroid Biochem Mol Biol 97:13
Ziegler R (2001) Hypercalcemic crisis. J Am Soc Nephrol 12(Suppl 17):S3
Lee IT, Sheu WH, Tu ST et al (2006) Bisphosphonate pretreatment attenuates hungry bone syndrome postoperatively in subjects with primary hyperparathyroidism. J Bone Miner Metab 24:255
Corsello SM, Paragliola RM, Locantore P et al (2010) Post-surgery severe hypocalcemia in primary hyperparathyroidism preoperatively treated with zoledronic acid. Hormones (Athens) 9:338
Rubin MR, Bilezikian JP, McMahon DJ et al (2008) The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 93:3462
Jorde R, Szumlas K, Haug E, Sundsfjord J (2002) The effects of calcium supplementation to patients with primary hyperparathyroidism and a low calcium intake. Eur J Nutr 41:258
Locker FG, Silverberg SJ, Bilezikian JP (1997) Optimal dietary calcium intake in primary hyperparathyroidism. Am J Med 102:543
Silverberg SJ, Shane E, Dempster DW, Bilezikian JP (1999) The effects of vitamin D insufficiency in patients with primary hyperparathyroidism. Am J Med 107:561
Khan AA, Bilezikian JP, Kung AW et al (2004) Alendronate in primary hyperparathyroidism: a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab 89:3319
Marcocci C, Chanson P, Shoback D et al (2009) Cinacalcet reduces serum calcium concentrations in patients with intractable primary hyperparathyroidism. J Clin Endocrinol Metab 94:2766
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© 2012 Springer-Verlag Berlin Heidelberg
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Holt, E.H. (2012). Preoperative Evaluation. In: Oertli, D., Udelsman, R. (eds) Surgery of the Thyroid and Parathyroid Glands. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-23459-0_30
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DOI: https://doi.org/10.1007/978-3-642-23459-0_30
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